RFP 25-009 Library of Attachments.pdf

PROPOSAL SUBMISSION CHECKLIST

OMH reserves the right to disqualify any proposals that do not contain the mandatory items as specified for this Solicitation and the resulting Contract. Vendors should use the following checklist as a guide when submitting proposals and include all required documents (mark the box to indicate inclusion of the documents):

VOLUME 1 - TECHNICAL PROPOSAL

VOLUME 2 – FINANCIAL PROPOSAL

VOLUME 3 – ADMINISTRATIVE PROPOSAL

Required document Type of Submission Included w/ Submission

Proposal Technical Responses

Include all narrative responses to the requirements as outlined in Section 5 of the RFP, including:

- Executive Summary

- Vendor Experience

- CEEP Required Services

Attachment L References

Provide completed copy with up to 3 references.

Attachment O Supplier Diversity Questionnaire

Include the completed copy

Required document Type of Submission Included w/ Submission

Attachment C Cost Proposal Worksheet

Include the completed copy

Required document Type of Submission Included w/ Submission

Attachment A Solicitation Cover Sheet

Provide completed and signed copy

Attachment B Intent to Bid

Provide completed and signed copy before bid due date.

Attachment B-1 No Bid Explanation

Provide completed and signed copy before bid due date.

Attachment D OMH Consultant Disclosure Reporting – Form A

Provide signed copy

Attachment E Non-Collusive Bidding Certification Provide a signed and notarized original

Attachment F Substitute W-9

Provide a signed copy if applicable

Attachment G and/or G-1 MWBE Utilization Plan and Request for Waiver

Provide completed and signed copy as applicable

Attachment H and/or H-1 SDVOB Utilization Plan and Request for Waiver

Provide completed and signed copy as applicable

Attachment I and/or I-1 MWBE/EEO Policy Statement, EEO Employment Opportunity Staffing Plan

Provide copies as applicable

Attachment J-1 Vendor’s Affirmation of Understanding of OMH Procurement Lobbying Guidelines

Provide completed and signed copy

Attachment J-2 Disclosure of Prior Non-Responsibility Determinations Non-Collusive Bidding Certification

Provide completed and signed copy

Attachment M Encouraging the Use of New York State Subcontractors and Suppliers

Provide copies as applicable

Attachment N New York State Business Usage Form

Provide copies as applicable

Attachment P Sexual Harassment Prevention Certification

Provide completed and signed copy

Attachment Q Gender-Based Violence and the Workplace Certification

Provide completed and signed copy

Attachment R Certification Under Executive Order 16

Provide completed and signed copy

Workers’ Compensation/NYS Disability Coverage required forms

If available, include verification of required coverage.

(will be required upon notice of award)

Liability Insurance Coverage If required, include verification of required coverage.

(will be required upon notice of award)

ST-220-CA:

Sales and Compensating Use Tax Certificate

Provide completed and signed copy

Dylan Brooks Rectangle

ATTACHMENT A

SOLICITATION COVER

SHEET RFP 25-009

NAME OF FIRM

ADDRESS

PRINTED NAME

TITLE

EMAIL ADDRESS

PHONE # FAX#

NYS VENDOR ID

FEDERAL ID (FEIN) #

IF THE COMPANY USES, OR HAS USED IN THE PAST TEN (10) YEARS, ANY OTHER BUSINESS NAME, FEIN, OR D/B/A PLEASE PROVIDE

Number of Years in Business: ____ Number of Years of Experience Providing Solicited Service: ____

PLEASE CHECK THE APPROPRIATE BOX:

NYS Minority-owned Business (MBE) Registration #

NYS Women-owned Business (WBE) Registration #

NYS Small Business (SB) Registration #

NYS Disadvantaged Business Enterprise (DBE) Registration #

NYS Service-Disabled Veteran Owned Enterprise (SDVOB) Registration #

None of the above

ATTESTATION:

By signature below, the Offeror hereby attest that they have read, understand, and are willing to comply the scope and requirements of this Request for Proposal. The Offeror also affirms that, to the best of their knowledge, the contents of their submitted proposal are truthful and accurate, meeting all mandatory requirements as presented.

PRINTED NAME: _____________________________

AUTHORIZED SIGNATURE: ____________________________ DATE: ____________

ATTACHMENT B

NOTICE OF INTENT TO BID

Solicitation #: RFP 25-009

Title: Comprehensive Energy Efficiency Program

This notice acknowledges that the undersigned prospective Bidder has read and understands the terms and conditions set forth in this solicitation and intends to submit a formal Bid response by the Due Date and Time indicated for consideration of contract award.

Furthermore, the Bidder acknowledges that any contract(s) resulting from this solicitation will be substantially in accordance with the standard OMH and New York State terms and conditions, as set forth in the associated OMH Contract Boilerplate and this solicitation.

FIRM NAME:

CONTACT NAME:

CONTACT TITLE:

MAILING ADDRESS:

EMAIL:

PHONE:

AUTHORIZED SIGNATURE: ___________________________________________

NAME: _________________________________ DATE:__________________

Additionally, please indicate if your firm would be interested in being contacted by other participating

Bidder for potential partnership or subcontracting opportunities that may arise through this solicitation.

Contact information for those interested in potential subcontracting may be shared and published to other responsive Bidders to facilitate potential opportunities.

☐ Yes, our firm may be interested in potential subcontracting opportunities

Attachment B-1 - No Bid Explanation Sheet

RFP #: 25-009

Comprehensive Energy Efficiency Program

Please return no later than the Bid Due Date

TO: Dylan Brooks Email: Dylan.Brooks@omh.ny.gov Contract Management Specialist

OMH BPES

FROM: ________________________________/____________________________

(Print Company Representative Name) Signature

COMPANY NAME: ______________________

(PRINT)

ADDRESS: ______________________

(PRINT)

Email address for designated point of contact:

I do not wish to submit a bid for the above solicitation due to:

Attachment D Consultant Disclosure Form A

OSC Use Only:

Reporting Code:

Category Code:

Date Contract Approved:

FORM A

State Consultant Services - Contractor's Planned Employment

From Contract Start Date Through The End Of The Contract Term

State Agency Name: Agency Code:

Contractor Name: Contract Number:

Contract Start Date: Contract End Date:

Employment Category1 Number of Employees

Number of hours to be worked

Amount Payable Under the Contract

Total this page 0 0

Grand Total

Name of person who prepared this report:

Title: Phone #:

Preparer's Signature:

Date Prepared:

(Use additional pages, if necessary) Page 1 of 1

1. (Note: Access the O*NET database, which is available through the US Department of Labor’s Employment and Training Administration, on-line at online.onetcenter.org to find a list of occupations.)

http://online.onetcenter.org/

ATTACHMENT E

NON-COLLUSIVE BIDDING CERTIFICATION

REQUIRED BY SECTION 139-D OF THE STATE FINANCE LAW

(Page 1 of 3)

SECTION 139-D, Statement of Non-Collusion in bids to the State:

BY SUBMISSION OF THIS BID, BIDDER AND EACH PERSON SIGNING ON BEHALF OF BIDDER

CERTIFIES, AND IN THE CASE OF JOINT BID, EACH PARTYTHERETO CERTIFIES AS TO ITS OWN ORGANIZATION, UNDER PENALTY OF PERJURY, THAT TO THE BEST OF HIS/HER KNOWLEDGE AND

BELIEF:

[1] The prices of this bid have been arrived at independently, without collusion, consultation, communication, or agreement, for the purposes of restricting competition, as to any matter relating to such prices with any other Bidder or with any competitor;

[2] Unless otherwise required by law, the prices which have been quoted in this bid have not been knowingly disclosed by the Bidder and will not knowingly be disclosed by the Bidder prior to opening, directly or indirectly, to any other Bidder or to any competitor; and

[3] No attempt has been made or will be made by the Bidder to induce any other person, partnership or corporation to submit or not to submit a bid for the purpose of restricting competition.

A BID SHALL NOT BE CONSIDERED FOR AWARD NOR SHALL ANYAWARD BE MADE WHERE [1], [2], [3] ABOVE HAVE NOT BEEN COMPLIED WITH; PROVIDED HOWEVER, THAT IF IN ANY CASE THE

BIDDER(S) CANNOT MAKE THE FOREGOING CERTIFICATION, THE BIDDER SHALL SO STATE AND

SHALL FURNISH BELOW A SIGNED STATEMENT WHICH SETS FORTH IN DETAIL THE REASONS

THEREFORE:

[AFFIX ADDENDUM TO THIS PAGE IF SPACE IS REQUIRED FOR STATEMENT.]

Subscribed to under penalty of perjury under the laws of the State of New York, this _______ day of ___________, 20____ as the act and deed of said corporation of partnership.

REQUIRED BY SECTION 139-D OF THE STATE FINANCE LAW

(Page 2 of 3)

IF BIDDER(S) (ARE) A PARTNERSHIP, COMPLETE THE FOLLOWING:

NAMES OF PARTNERS OR PRINCIPALS LEGAL RESIDENCE

IF BIDDER(S) (ARE) A CORPORATION, COMPLETE THE FOLLOWING:

NAME LEGAL RESIDENCE

President:

Secretary:

Treasurer:

President:

Secretary:

Treasurer:

IF BIDDER(S) (ARE) A LIMITED LIABILITY COMPANY (LLC), COMPLETE THE FOLLOWING:

NAMES OF MEMBERS LEGAL RESIDENCE

REQUIRED BY SECTION 139-D OF THE STATE FINANCE LAW

(Page 3 of 3)

Identifying Data Potential Contractor: ___________________________________________________________ Address: ___________________________________________________________

Street

City, Town, etc.

Telephone: __________________________ Title__________________________

If applicable, Responsible Corporate Officer:

Name: ______________________________ Title__________________________

Signature: _______________________________________________________________

Joint or combined bids by companies or firms must be certified on behalf of each participant.

Legal name of person, firm or corporation Legal name of person, firm or corporation

By: _____________________________ ______________________________ Name Name

Title Title

Address: _________________________ Address: _________________________ Street Street

City, State City, State

AC 3237-S (Rev. 1/17)

NEW YORK STATE OFFICE OF THE STATE COMPTROLLER

SUBSTITUTE FORM W-9:

REQUEST FOR TAXPAYER IDENTIFICATION NUMBER & CERTIFICATION

TYPE OR PRINT INFORMATION NEATLY. PLEASE REFER TO INSTRUCTIONS FOR MORE INFORMATION.

Part I: Vendor Information

1. Legal Business Name: 2. Business name/disregarded entity name, if different from Legal Business Name:

3. Entity Type (Check one only):

Individual Sole Proprietor Partnership Limited Liability Co. Corporation Not For Profit

Trusts/Estates Federal, State or Local Government Public Authority Disregarded Entity

Other _______________________________

Exempt

…….Payee

Part II: Taxpayer Identification Number (TIN) & Taxpayer Identification Type

1. Enter your TIN here: (DO NOT USE DASHES) See instructions.

2. Taxpayer Identification Type (check appropriate box):

Employer ID No. (EIN) Social Security No. (SSN) Individual Taxpayer ID No. (ITIN) N/A (Non-United States Business Entity)

Part III: Address

1. Remittance Address: 2. Ordering Address:

Number, Street, and Apartment or Suite Number Number, Street, and Apartment or Suite Number

City, State, and Nine Digit Zip Code or Country City, State, and Nine Digit Zip Code or Country

Email Address

Part IV: Vendor Primary Contact Information – Executive Authorized to Represent the Vendor

Primary Contact Name: ________________________________________________ Title:__________________________________________

Email Address: _______________________________________________________ Phone Number: ________________________

Part V: Certification and Exemption from Backup Withholding

Under penalties of perjury, I certify that:

1. The number shown on this form is my correct taxpayer identification number (TIN), and

2. I am a U.S. citizen or other U.S. person, and

3. (Check one only):

I am not subject to backup withholding. I am (a) exempt from back up withholding, or (b) I have not been notified by the

Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or

(c) the IRS has notified me that I am no longer subject to backup withholding),or

I am subject to backup withholding. I have been notified by the IRS that I am subject to backup withholding as a result of a failure to report all interest or dividends, and I have not been notified by the IRS that I am no longer subject to back withholding.

Sign Here:

Signature Title Date

Print Preparer's Name Phone Number Email Address

DO NOT SUBMIT FORM TO IRS – SUBMIT FORM TO NYS ONLY AS DIRECTED

Attachment F: W9 Form

AC 3237-S (Rev. 1/17)

NYS Office of the State Comptroller

Instructions for Completing Substitute Form W-9

New York State (NYS) must obtain your correct Taxpayer Identification Number (TIN) to report income paid to you or your organization. NYS Office of the State Comptroller uses the Substitute Form W-9 to obtain certification of your TIN in order to ensure accuracy of information contained in its payee/vendor database and to avoid backup withholding.1 We ask for the information on the Substitute Form W-9 to carry out the Internal Revenue laws of the United States. You are required to give us the information.

Any payee/vendor who wishes to do business with New York State must complete the Substitute Form W-9. Substitute Form W-9 is the only acceptable documentation. We will not accept IRS Form W-9.

Part I: Vendor Information

1. Legal Business Name: For individuals, enter the name of the person who will do business with NYS as it appears on the Social Security card or other required Federal tax documents. An organization should enter the name shown on its charter or other legal documents that created the organization. Do not abbreviate names.

2. Business name/disregarded entity name, if different from Legal Business Name: Enter your DBA name or another name your entity is known by.

3. Entity Type: Check the Entity Type doing business with New York State.

Part II: Taxpayer Identification Number (TIN) and Taxpayer Identification Type

The TIN provided must match the name in the “Legal Business Name” box to avoid backup withholding.

For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, refers to IRS W-9 instructions for additional information. For other entities, it is your employer identification number (EIN). If you do not have a number or if the account is in more than one name, refer to IRS W-9 instructions for additional information.

1. Taxpayer Identification Number: Enter your nine-digit Social Security Number, Individual Taxpayer Identification Number (ITIN) or Employer Identification Number (EIN).

2. Taxpayer Identification Type: Check the type of identification number provided.

Part III: Address

1. Remittance Address: Enter the address where payments, 1099s, if applicable, and official correspondence should be mailed. This will become the default address.

2. Ordering Address: Enter the address where purchase orders should be sent. Please note that purchase orders will be sent via email by default.

Part IV: Vendor Primary Contact Information Please provide the contact information for an executive at your organization. This individual should be the person who makes legal and financial decisions for your organization. Name, phone number and email address are required.

Part V: Certification and Exemption from Backup Withholding Check the appropriate box indicating your exemption status from backup withholding. Individuals and sole proprietors are not exempt from backup withholding. Corporations are exempt from backup withholding for certain types of payments. Refer to IRS Form W-9 instructions for additional information. The signature should be provided by the individual, owner, officer, legal representative, or other authorized person of the entity listed on the form. Certain exceptions to the signature requirement are listed in the IRS instructions for form W-9.

1 According to IRS Regulations, OSC must withhold 28% of all payments if a payee/vendor fails to provide OSC its certified TIN. The Substitute Form W-9 certifies a payee/vendor’s TIN.

Attachment F: W9 Form

ATTACHMENT G

MWBE Utilization Plan

1. Offeror/Contractor Name: 4. Telephone : 8. Contract No. 11. Contract Goals:

MBE: 16%

WBE: 14%

5. Email Address: 9. Total Contract Value: $

2. Address: 6. Federal ID: 10. Contract Description: 12. Adjusted Goals:

MBE: %

WBE: %

3. City, State, Zip: 7. SFS Vendor ID:

13. MWBE Subcontractor.

(attach sheets as necessary)

14. Classification. 15. Description of Work/Supplies 16. Value of Subcontracts/Supplies/Services

Name: MBE Direct (Spending directly fulfilling contract obligations.)

Description:

Address:

WBE

City/State/Zip: Indirect (Spending in support of company operations.)

Description:

Telephone: Dual

Email Address: Fed. ID. NO: SFS Vendor ID:

Name:

MBE Direct (Spending directly fulfilling contract obligations.)

Description:

Address:

WBE

City/State/Zip: Indirect (Spending in support of company operations.)

Description:

Telephone: Dual

Email Address: Fed. ID. NO: SFS Vendor ID: Total M/WBE Expenditures: $

FOR AUTHORIZED USE ONLY

VENDOR CERTIFICATION: I hereby affirm that the information supplied in this utilization plan is true and correct.

SUBMISSION OF THIS FORM CONSTITUTES THE OFFEROR/CONTRACTOR'S ACKNOWLEDGEMENT AND AGREEMENT TO COMPLY WITH THE M/WBE REQUIREMENTS SET FORTH UNDER NYS EXECUTIVE LAW, ARTICLE 15-A, 5 NYCRR PART 142, AND THE ABOVE REFERENCED SOLICITATION. FAILURE TO SUBMIT COMPLETE AND ACCURATE INFORMATION MAY RESULT IN A FINDING OF

NONCOMPLIANCE AND/OR TERMINATION OF THE CONTRACT.

Signature: ________________________________ Print Name:____________________________________

Title: ____________________________________ Date: ____________________________________

Utilization Plan Approved: Y N Date:__________________

Notice of Deficiency Issued: Y N Date:__________________

Notice of Acceptance Issued: Y N Date:__________________

Reviewed By: ______________________________

Comment(s):

Date:__________________

ATTACHMENT G-1

APPLICATION FOR WAIVER OF M/WBE PARTICIPATION GOALS

This form must be submitted for review and approval by the NYS Office of Mental Health M/WBE liaison and the Governor’s staff. Waiver approval must be received prior to the completion of the contract and a prerequisite for full and final payment.

SECTION 1: BASIC INFORMATION

Contractor’s Name: Federal ID

Number:

SFS Vendor ID Number:

Street Address: E-Mail Address:

City, State, Zip Code: Telephone:

Contract Number: Contract Value: $

Description of Contract: M/WBE Goals Assigned to the Contract:

MBE % WBE%

SECTION 2: TYPE OF M/WBE WAIVER REQUESTED

MBE Waiver Total Waiver Partial Waiver If partial waiver is being requested please indicate the proposed MBE utilization: %

WBE Waiver Total Waiver Partial Waiver If partial waiver is being requested please indicate the proposed WBE utilization: % Does a certified M/WBE exist anywhere in New York State that can provide at least 20% of the products and/or services needed to the contract? If so, please explain in detail the reason you are requesting a waiver. (Attach additional sheets if necessary).

SECTION 3: SUPPORTING DOCUMENTATION

Provide the following documentation as evidence of your good faith efforts to meet the M/WBE goals set forth in the contract and support of your waiver application: (Please check all that apply and include attachments).

Attachment A. List of the general circulation, trade and M/WBE specific publications and dates of publications in which your firm solicited for certified M/WBE participation as a subcontractor/supplier and copies of such publications.

Attachment B. List of the certified M/WBEs found in the New York State Contracting System M/WBE Directory (https://ny.newnycontracts.com/) that were solicited for this contract. Provide proof of the dates or copies of the solicitations and copies of the responses made by the certified M/WBEs. Describe specific reasons that responding certified M/WBEs were not selected.

Attachment C. Descriptions of the contract documents/plans/specifications made available to certified M/WBEs by the contractor when soliciting their participation and steps taken to structure the scope of work for the purpose of subcontracting with or obtaining supplies from certified M/WBEs.

Attachment D. Description of the negotiations between the contractor and certified M/WBEs for the purposes of complying with the M/WBE goals for this contract.

Attachment E. Identify dates of pre-bid, pre-award or other meetings attended by the contractor and scheduled by OMH with certified M/WBEs whom OMH determined were capable of fulfilling the M/WBE goals set in the contract.

Attachment F. Any other information deemed relevant to the request for waiver.

SECTION 4: SIGNATURE AND CONTACT INFORMATION

DECLARATION: The undersigned certifies that he or she is authorized by the Contractor identified above to make this declaration. The Contractor has made good faith efforts, as defined in NYS law, to meet the M/WBE goals contained in NYS law and under the applicable contract. The undersigned acknowledges that failure to submit complete and accurate information in connection with a waiver request may result in denial and/or a finding of non-compliance. Failure to establish good faith efforts may result in suspension or termination of a New York State contract.

Prepared By : (Signature) Date:

Name and Title of Preparer:

https://ny.newnycontracts.com/

This form must be submitted for review and approval by the NYS Office of Mental Health M/WBE liaison and the Governor’s staff. Waiver approval must be received prior to the completion of the contract and a prerequisite for full and final payment.

The Freedom of Information Law requires public disclosure of certain records held by NYS OMH. Based upon the foregoing, you are hereby notified that this document, and related documents, constitutes “records” that fall under the scope of the Freedom of Information Law. Therefore, such documents may be made available to the public.

This form must be submitted for review and approval by the NYS Office of Mental Health M/WBE liaison and the Governor’s staff. Waiver approval must be received prior to the completion of the contract and a prerequisite for full and final payment.

Instructions for Completing and Submitting an Application for a Waiver of M/WBE Utilization Goals

Article 15-A of the New York State Executive Law and 5 NYCRR 140-145 require State Agencies to increase participation by Minority and Women-Owned Business Enterprises (M/WBEs) on State contracts. All solicitations are reviewed and have goals established for them for both MBE and WBE utilization. The goals are expressed as a percentage of the anticipated payments made under the contract. A state agency shall not grant any automatic waivers of goal requirements on a State contract. A State agency may grant a partial or total waiver of goal requirements upon submission and approval of a waiver application documenting a contractor’s good faith efforts. Governor’s Office Executive Chamber approval is also a requirement of a State Agency waiver approval. Failure to make good faith efforts may result in a State contract being awarded to another bidder, or, if the contract is already in progress, may result in financial penalties.

Section 1: Basic Information

Complete all sections including the contractor’s name, address federal identification number, State Financial System (SFS) vendor identification number and contract number. Please provide a current e-mail address and telephone number where the firms authorized representative may be reached. In the space provided, please provide a detailed description of the contract. Where requested, please state the original M/WBE utilization goals that were established for the contract.

Section 2: Type of Waiver Request

In this section please indicate the type of waiver being requested. If requesting a partial waiver, please provide the revised utilization goal percentage being proposed by the firm. In the space provided, explain in detail the need of a waiver of the M/WBE participation goals.

Section3: Supporting Documentation Demonstrating Good Faith Efforts requires extensive documentation in order to comply with the requirements of Article 15-A of the Executive Law. See the form for specific details on the documentation required and check all that apply.

Section 4: Signature and Contact Information The waiver application must be signed by an authorized official of the firm who will be responsible for the contract. By signing the waiver application, the authorized official is certifying that he or she is authorized to make the DECLARATION that has been set forth, and that the Contractor has made good faith efforts, as defined in NYS law, to meet the M/WBE goals contained in NYS law and under the applicable contract. The undersigned acknowledges that failure to submit complete and accurate information in connection with a waiver request may result in denial and/or a finding of noncompliance. Failure to establish good faith efforts may result in suspension or termination of a New York State contract. Please state the date that the Application for Waiver of M/WBE Participation Goals was signed by the authorized official who is responsible for the contract.

For NYS OMH USE ONLY:

Review By:

Title:

Date:

OMH Waiver Recommendation

Full MBE Waiver be granted

Partial MBE Waiver granted, revised MBE goal: %

MBE Waiver denied

Full WBE Waiver be granted

Partial WBE Waiver granted, revised WBE goal: %

WBE Waiver denied

Executive Chamber Waiver Recommendation Approve Deny Date of Decision:

Date Notice of Determination sent to Contractor:

Comments:

ATTACHMENT H

SDVOB CONTRACTOR UTILIZATION PLAN

SDVOB UTILIZATION PLAN Initial Plan

Revised plan

Contract/Solicitatio n

INSTRUCTIONS: This Utilization Plan must contain a detailed description of the supplies and/or services to be provided by each NYS Certified Service-Disabled Veteran-Owned Business (SDVOB) under the contract. By submission of this Plan, the Bidder/Contractor commits to making good faith efforts in the utilization of SDVOB subcontractors and suppliers as required by the SDVOB goals contained in the Solicitation/Contract. Making false representations or providing information that shows a lack of good faith as part of, or in conjunction with, the submission of a Utilization Plan is prohibited by law and may result in penalties including, but not limited to, termination of a contract for cause, loss of eligibility to submit future bids, and/or withholding of payments. Firms that do not perform commercially useful functions may not be counted toward SDVOB utilization. Attach additional sheets if necessary.

BIDDER/CONTRACTOR INFORMATION SDVOB Goals In Contract

Bidder/Contractor Name: NYS Vendor ID: 6%

Bidder/Contractor Address (Street, City, State and Zip Code):

Bidder/Contractor Telephone Number: Contract Work Location/Region: Long Island

Contract Description/Title:

CONTRACTOR INFORMATION

Prepared by (Signature): Name and Title of Preparer:

Matthew Ramsey CMS2 Telephone Number:

518-549-5221

Date:

7/31/19

Email Address:

If unable to meet the SDVOB goals set forth in the solicitation/contract, bidder/contractor must submit a request for waiver on the SDVOB Waiver Form.

SDVOB Subcontractor/Supplier Name:

Please identify the person you contacted: Federal Identification No.: Telephone No.:

Address: Email Address:

Detailed description of work to be provided by subcontractor/supplier:

Dollar Value of subcontracts/supplies/services (When $ value cannot be estimated, provide the estimated % of contract work the SDVOB will perform): $ or %

SDVOB Subcontractor/Supplier Name:

Please identify the person you contacted: Federal Identification No.: Telephone No.:

Address: Email Address:

Detailed Description of work to be provided by subcontractor/supplier:

Dollar Value of subcontracts/supplies/services (When $ value cannot be estimated, provide the estimated % of contract work the SDVOB will perform): $ or %

FOR OMH USE ONLY

OMH Authorized Signature: Accepted Accepted as

Noted Notice of

Deficiency NAME (Please Print): SDVOB

Date Received: Date Processed:

Comments:

NYS CERTIFIED SDVOB SUBCONTRACTOR/SUPPLIER INFORMATION: The directory of New York State Certified SDVOBs can be viewed at: https://online.ogs.ny.gov/SDVOB/search Note: All listed Subcontractors/Suppliers will be contacted and verified by OMH.

ADDITIONAL SHEET

Bidder/Contractor Name: Contract/Solicitati on

SDVOB Subcontractor/Supplier Name:

Please identify the person you contacted: Federal Identification No.: Telephone No.:

Address: Email Address:

Detailed Description of work to be provided by subcontractor/supplier:

Dollar Value of subcontracts/supplies/services (When $ value cannot be estimated, provide the estimated % of contract work the SDVOB will perform): $ or %

SDVOB Subcontractor/Supplier Name:

Please identify the person you contacted: Federal Identification No.: Telephone No.:

Address: Email Address:

Detailed Description of work to be provided by subcontractor/supplier:

Dollar Value of subcontracts/supplies/services (When $ value cannot be estimated, provide the estimated % of contract work the SDVOB will perform): $ or %

SDVOB Subcontractor/Supplier Name:

Please identify the person you contacted: Federal Identification No.: Telephone No.:

Address: Email Address:

Detailed Description of work to be provided by subcontractor/supplier:

Dollar Value of subcontracts/supplies/services (When $ value cannot be estimated, provide the estimated % of contract work the SDVOB will perform): $ or %

SDVOB Subcontractor/Supplier Name:

Please identify the person you contacted: Federal Identification No.: Telephone No.:

Address: Email Address:

Detailed Description of work to be provided by subcontractor/supplier:

Dollar Value of subcontracts/supplies/services (When $ value cannot be estimated, provide the estimated % of contract work the SDVOB will perform)): $ or %

SDVOB Subcontractor/Supplier Name:

Please identify the person you contacted: Federal Identification No.: Telephone No.:

Address: Email Address:

Detailed Description of work to be provided by subcontractor/supplier:

Dollar Value of subcontracts/supplies/services (When $ value cannot be estimated, provide the estimated % of contract work the SDVOB will perform): $ or %

ATTACHMENT H-1

APPLICATION FOR WAIVER OF SDVOB PARTICIPATION GOAL

(must be submitted before requesting final payment on the Contract) Section 1: Basic Information Contractor’s Name: Federal Identification Number:

Street Address: E-Mail Address:

City, State, Zip Code: Telephone:

Contract Number: SDVOB CONTRACT GOALS

Section 2: Type of SDVOB Waiver Requested Total Partial If partial waiver, please enter the revised SDVOB percentage:

Please explain the reason for the waiver request:

Section 3: Supporting Documentation

Provide the following documentation as evidence of your good faith efforts to meet the SDVOB goals set forth in the contract and in support of your waiver application:

Attachment A. Copies of solicitations to SDVOBs and any responses thereto.

Attachment B. Explanation of the specific reasons each SDVOB that responded to Bidders/Contractors’ solicitation was not selected.

Attachment C. Dates of any pre-bid, pre-award or other meetings attended by Contractor, if any, scheduled by OMH with certified

SDVOBs whom OMH determined were capable of fulfilling the SDVOB goals set forth in the contract.

Attachment D. Information describing the specific steps undertaken to reasonably structure the contract scope of work for the purpose of subcontracting with, or obtaining supplies from, certified SDVOBs.

Attachment E. Other information deemed relevant to the request.

Section 4: Signature and Contact Information By signing and submitting this form, the contractor certifies that a good faith effort has been made to promote SDVOB participation pursuant to the SDVOB requirements set forth under the solicitation or Contract. Failure to submit complete and accurate information may result in a finding of noncompliance, non-responsibility, and a suspension or termination of the contract.

Prepared By: (Signature) Date:

Name and Title of Preparer (Print or Type)

For OMH Use Only Reviewed By: Date:

Decision:

Full SDVOB waiver granted Partial SDVOB waiver granted; revised SDVOB goal: _______ % SDVOB waiver denied

Approved By: Date:

Date Notice of Determination Sent:

Comments

ATTACHMENT I

CONTRACTOR REQUIREMENTS AND PROCEDURES FOR BUSINESS PARTICIPATION OPPORTUNITIES FOR

VENDORS CERTIFIED PURSUANT TO ARTICLE 15-A AND 17-E

NEW YORK STATE LAW

Pursuant to New York State Executive Law Article 15-A and 5 NYCRR 140-145 OMH recognizes its obligation under the law to promote opportunities for maximum feasible participation of certified minority-and women-owned business enterprises and the employment of minority group members and women in the performance of OMH contracts.

In 2006, the State of New York commissioned a disparity study to evaluate whether minority and women-owned business enterprises had a full and fair opportunity to participate in state contracting. The findings of the study were published on April 29, 2010, under the title "The State of Minority and Women-Owned Business Enterprises:

Evidence from New York" (“Disparity Study”). The report found evidence of statistically significant disparities between the level of participation of minority-and women-owned business enterprises in state procurement contracting versus the number of minority-and women-owned business enterprises that were ready, willing and able to participate in state procurements. As a result of these findings, the Disparity Study made recommendations concerning the implementation and operation of the statewide certified minority- and women-owned business enterprises program. The recommendations from the Disparity Study culminated in the enactment and the implementation of New York State Executive Law Article 15-A, which requires, among other things, that OMH establishes goals for maximum feasible participation of New York State Certified minority- and women – owned business enterprises (“MWBE”) and the employment of minority groups members and women in the performance of New York State contracts.

Business Participation Opportunities for MWBEs

For purposes of this procurement, OMH hereby establishes an overall goal of 30% for MWBE participation, 16% for New York State certified minority-owned business enterprises (“MBE”) participation and 14% for New York State certified women-owned business enterprises (“WBE”) participation (based on the current availability of qualified MBEs and WBEs). A contractor (“Contractor”) on the subject contract (“Contract”) must document its good faith efforts to provide meaningful participation by MWBEs as subcontractors or suppliers in the performance of the Contract and the Contractor agrees that OMH may withhold payment pending receipt of the required MWBE documentation. The directory of MWBEs can be viewed at: https://ny.newnycontracts.com. For guidance on how OMH will determine a Contractor’s “good faith efforts,” refer to 5 NYCRR §142.8.

In accordance with 5 NYCRR §142.13, the Contractor acknowledges that if it is found to have willfully and intentionally failed to comply with the MWBE participation goals set forth in the Contract, such finding constitutes a breach of Contract and OMH may withhold payment from the Contractor as liquidated damages.

Such liquidated damages shall be calculated as an amount equaling the difference between: (1) all sums identified for payment to MWBEs had the Contractor achieved the contractual MWBE goals; and (2) all sums actually paid to MWBEs for work performed or materials supplied under the Contract.

By submitting a bid or proposal, a bidder on the Contract (“Bidder”) agrees to demonstrate its good faith efforts to achieve its goals for the utilization of MWBEs by submitting evidence thereof through the New York State Contract System (“NYSCS”), which can be viewed at https://ny.newnycontracts.com, provided, however, that a Bidder may arrange to provide such evidence via a non-electronic method by contacting the Agency contact.

Please note that the NYSCS is a one stop solution for all of your MWBE and Article 15-A contract requirements.

For additional information on the use of the NYSCS to meet Bidder’s MWBE requirements please see the attached MWBE guidance, “Your MWBE Utilization and Reporting Responsibilities Under Article 15-A.”

Additionally, a Bidder will be required to submit the following documents and information as evidence of compliance with the foregoing:

A. An MWBE Utilization Plan with their bid or proposal. Any modifications or changes to the MWBE Utilization Plan after the Contract award and during the term of the Contract must be reported on a revised MWBE Utilization Plan and submitted to OMH.

OMH will review the submitted MWBE Utilization Plan and advise the Bidder of OMH acceptance or issue a notice of deficiency within 30 days of receipt.

CONTRACTOR REQUIREMENTS AND PROCEDURES FOR BUSINESS PARTICIPATION OPPORTUNITIES FOR VENDORS

CERTIFIED PURSUANT TO ARTICLE 15-A AND 17-E

B. If a notice of deficiency is issued, the Bidder will be required to respond to the notice of deficiency within seven (7) business days of receipt by submitting to cbomwbe@omh.ny.gov a written remedy in response to the notice of deficiency. If the written remedy that is submitted is not timely or is found by OMH to be inadequate, OMH shall notify the Bidder and direct the Bidder to submit, within five (5) business days, a request for a partial or total waiver of MWBE participation goals. Failure to file the waiver form in a timely manner may be grounds for disqualification of the bid or proposal.

OMH may disqualify a Bidder as being non-responsive under the following circumstances:

a) If a Bidder fails to submit a MWBE Utilization Plan;

b) If a Bidder fails to submit a written remedy to a notice of deficiency;

c) If a Bidder fails to submit a request for waiver; or

d) If OMH determines that the Bidder has failed to document good faith efforts.

The Contractor will be required to attempt to utilize, in good faith, any MBE or WBE identified within its MWBE Utilization Plan, during the performance of the Contract. Requests for a partial or total waiver of established goal requirements made subsequent to Contract Award may be made at any time during the term of the Contract to OMH, but must be made no later than prior to the submission of a request for final payment on the Contract.

The Contractor will be required to submit a Contractor’s Quarterly M/WBE Contractor Compliance & Payment Report to the OMH, by the 10th day following each end of quarter over the term of the Contract documenting the progress made toward achievement of the MWBE goals of the Contract.

Equal Employment Opportunity Requirements

By submission of a bid or proposal in response to this solicitation, the Bidder/Contractor agrees with all of the terms and conditions of Appendix A – Standard Clauses for All New York State Contracts including Clause 12 - Equal Employment Opportunities for Minorities and Women. The Contractor is required to ensure that it and any subcontractors awarded a subcontract over $25,000 for the construction, demolition, replacement, major repair, renovation, planning or design of real property and improvements thereon (the "Work"), except where the Work is for the beneficial use of the Contractor, undertake or continue programs to ensure that minority group members and women are afforded equal employment opportunities without discrimination because of race, creed, color, national origin, sex, age, disability or marital status. For these purposes, equal opportunity shall apply in the areas of recruitment, employment, job assignment, promotion, upgrading, demotion, transfer, layoff, termination, and rates of pay or other forms of compensation. This requirement does not apply to: (i) work, goods, or services unrelated to the Contract; or (ii) employment outside New York State.

The Bidder will be required to submit a Minority and Women-Owned Business Enterprises and Equal Employment Opportunity Policy Statement, ATTACHMENT I-1, to OMH with their bid or proposal.

Pursuant to Executive Order #162, contractors and subcontractors will also be required to report the gross wages paid to each of their employees for the work performed by such employees on the contract utilizing the Workforce Utilization Report on a quarterly basis.

Further, pursuant to Article 15 of the Executive Law (the “Human Rights Law”), all other State and Federal statutory and constitutional non-discrimination provisions, the Contractor and sub-contractors will not discriminate against any employee or applicant for employment because of race, creed (religion), color, sex, national origin, sexual orientation, military status, age, disability, predisposing genetic characteristic, marital status or domestic violence victim status, and shall also follow the requirements of the Human Rights Law with regard to non-discrimination on the basis of prior criminal conviction and prior arrest.

Please Note: Failure to comply with the foregoing requirements may result in a finding of non-responsiveness, non-responsibility and/or a breach of the Contract, leading to the withholding of funds, suspension or termination of the Contract or such other actions or enforcement proceedings as allowed by the Contract.

CERTIFIED PURSUANT TO ARTICLE 15-A AND 17-E

PARTICIPATION OPPORTUNITIES FOR NEW YORK STATE CERTIFIED SERVICE-DISABLED VETERAN

OWNED BUSINESSES

Article 17-B of the New York State Executive Law provides for more meaningful participation in public procurement by certified Service-Disabled Veteran-Owned Businesses (“SDVOB”), thereby further integrating such businesses into New York State’s economy. OMH recognizes the need to promote the employment of service-disabled veterans and to ensure that certified service-disabled veteran-owned businesses have opportunities for maximum feasible participation in the performance of OMH contracts.

In recognition of the service and sacrifices made by service-disabled veterans and in recognition of their economic activity in doing business in New York State, Bidders are expected to consider SDVOBs in the fulfillment of the requirements of the Contract. Such participation may be as subcontractors or suppliers, as protégés, or in other partnering or supporting roles.

I. Contract Goals

A. OMH hereby establishes an overall goal of 6% for SDVOB participation, based on the current availability of qualified SDVOBs. For purposes of providing meaningful participation by SDVOBs, the Bidder/Contractor should reference the directory of New York State Certified SDVOBs found at:

https://ogs.ny.gov/veterans/Docs/CertifiedNYS_SDVOB.pdf. Questions regarding compliance with SDVOB participation goals should be directed to the cbomwbe@omh.ny.gov. Additionally, following Contract execution, Contractor is encouraged to contact the Office of General Services’ Division of Service-Disabled Veterans’ Business Development at 518-474-2015 or VeteransDevelopment@ogs.ny.gov to discuss additional methods of maximizing participation by SDVOBs on the Contract.

B. Contractor must document “good faith efforts” to provide meaningful participation by SDVOBs as subcontractors or suppliers in the performance of the Contract (see clause IV below).

II. SDVOB Utilization Plan

A. In accordance with 9 NYCRR § 252.2(i), Bidders are required to submit a completed SDVOB Utilization Plan on Form SDVOB 100 with their bid.

B. The Utilization Plan shall list the SDVOBs that the Bidder intends to use to perform the Contract, a description of the work that the Bidder intends the SDVOB to perform to meet the goals on the Contract, the estimated dollar amounts to be paid to an SDVOB, or, if not known, an estimate of the percentage of Contract work the SDVOB will perform. By signing the Utilization Plan, the Bidder acknowledges that making false representations or providing information that shows a lack of good faith as part of, or in conjunction with, the submission of a Utilization Plan is prohibited by law and may result in penalties including, but not limited to, termination of a contract for cause, loss of eligibility to submit future bids, and/or withholding of payments. Any modifications or changes to the agreed participation by SDVOBs after the Contract award and during the term of the Contract must be reported on a revised SDVOB Utilization Plan and submitted to OMH.

C. OMH will review the submitted SDVOB Utilization Plan and advise the Bidder/Contractor of OMH acceptance or issue a notice of deficiency within 20 days of receipt.

D. If a notice of deficiency is issued, Bidder/Contractor agrees that it shall respond to the notice of deficiency, within seven business days of receipt, by submitting to OMH a written remedy in response to the notice of deficiency. If the written remedy that is submitted is not timely or is found by OMH to be inadequate, OMH shall notify the Bidder/Contractor and direct the Bidder/Contractor to submit, within five business days of notification by OMH, a request for a partial or total waiver of SDVOB participation goals on SDVOB 200. Failure to file the waiver form in a timely manner may be grounds for disqualification of the bid or proposal.

https://ogs.ny.gov/veterans/Docs/CertifiedNYS_SDVOB.pdf mailto:VeteransDevelopment@ogs.ny.gov

CERTIFIED PURSUANT TO ARTICLE 15-A AND 17-E

E. OMH may disqualify a Bidder’s bid or proposal as being non-responsive under the following circumstances:

(1) If a Bidder fails to submit an SDVOB Utilization Plan;

(2) If a Bidder fails to submit a written remedy to a notice of deficiency;

(3) If a Bidder fails to submit a request for waiver; or

(4) If OMH determines that the Bidder has failed to document good faith efforts.

F. If awarded a Contract, Contractor certifies that it will follow the submitted SDVOB Utilization Plan for the performance of SDVOBs on the Contract pursuant to the prescribed SDVOB contract goals set forth above.

G. Contractor further agrees that a failure to use SDVOBs as agreed in the Utilization Plan shall constitute a material breach of the terms of the Contract. Upon the occurrence of such a material breach, OMH shall be entitled to any remedy provided herein, including but not limited to, a finding of Contractor non-responsibility.

III. Request for Waiver

A. Prior to submission of a request for a partial or total waiver, Bidder/Contractor shall speak to the Agency contact(s) at OMH for guidance.

B. In accordance with 9 NYCRR § 252.2(m), a Bidder/Contractor that is able to document good faith efforts to meet the goal requirements, as set forth in clause IV below, may submit a request for a partial or total waiver on Form SDVOB 200, accompanied by supporting documentation. A Bidder may submit the request for waiver at the same time it submits its SDVOB Utilization Plan. If a request for waiver is submitted with the SDVOB Utilization Plan and is not accepted by OMH at that time, the provisions of clauses II (C), (D) & (E) will apply. If the documentation included with the Bidder’s/Contractor’s waiver request is complete, OMH shall evaluate the request and issue a written notice of acceptance or denial within 20 days of receipt.

C. Contractor shall attempt to utilize, in good faith, the SDVOBs identified within its SDVOB Utilization Plan, during the performance of the Contract. Requests for a partial or total waiver of established goal requirements made subsequent to Contract award may be made at any time during the term of the Contract to OMH, but must be made no later than prior to the submission of a request for final payment on the Contract.

D. If OMH, upon review of the SDVOB Utilization Plan and Monthly SDVOB Compliance Report (SDVOB

101) determines that Contractor is failing or refusing to comply with the contract goals and no waiver has been issued in regard to such non-compliance, OMH may issue a notice of deficiency to the Contractor.

The Contractor must respond to the notice of deficiency within seven business days of receipt. Such response may include a request for partial or total waiver of SDVOB contract goals.

Waiver requests should be sent to OMH.

IV. Required Good Faith Efforts

In accordance with 9 NYCRR § 252.2(n), Contractors must document their good faith efforts toward utilizing SDVOBs on the Contract. Evidence of required good faith efforts shall include, but not be limited to, the following:

(1) Copies of solicitations to SDVOBs and any responses thereto.

(2) Explanation of the specific reasons each SDVOB that responded to Bidders/Contractors’ solicitation was not selected.

(3) Dates of any pre-bid, pre-award or other meetings attended by Contractor, if any, scheduled by OMH with certified SDVOBs whom OMH determined were capable of fulfilling the SDVOB goals set in the Contract.

(4) Information describing the specific steps undertaken to reasonably structure the Contract scope of work for the purpose of subcontracting with, or obtaining supplies from, certified SDVOBs.

CERTIFIED PURSUANT TO ARTICLE 15-A AND 17-E

(5) Other information deemed relevant to the waiver request.

V. Monthly SDVOB Contractor Compliance Report

In accordance with 9 NYCRR § 252.2(q), Contractor is required to report Monthly SDVOB Contractor Compliance to OMH during the term of the Contract for the preceding month’s activity, documenting progress made towards achieving the Contract SDVOB goals. This information must be submitted using form SDVOB 101 (Exhibit 6) and should be completed by the Contractor and submitted to OMH, by the 10th day of each month during the term of the Contract, for the preceding month’s activity to: cbomwbe@omh.ny.gov

VI. Breach of Contract and Damages

In accordance with 9 NYCRR § 252.2(s), any Contractor found to have willfully and intentionally failed to comply with the SDVOB participation goals set forth in the Contract, shall be found to have breached the contract and Contractor shall pay damages as set forth therein.

ALL FORMS ARE AVAILABLE AT: https://ogs.ny.gov/veterans/

THIS SPACE INTENTIONALLY LEFT BLANK

https://ogs.ny.gov/veterans/

ATTACHM ENT I

MINORITY AND WOMEN-OWNED BUSINESS ENTERPRISES – EQUAL EMPLOYMENT

OPPORTUNITY POLICY STATEMENT

I, _________________________, the awardee/contractor, agree to adopt the following policies with respect to the project being developed or services rendered for the…